When keratoconus progresses to end stage, corneal transplant surgery is the only way to restore sight. The central area is removed from the cornea of a keratoconic eye and a central “button” from the donor eye is then sewn on in its place. In large part due to the fact that keratoconus is non-inflammatory, corneal transplant surgery is very successful for treatment of end stage keratoconus. Even when successful, however, this surgery is not a cure. Post-surgical care is continuous and may be needed forever to maintain the health of the transplant and avoid rejection. If the transplanted cornea comes out to be irregular, contact lenses may still be necessary for clear vision. This poses a whole new set of fitting difficulties but results can be very good.

The question is: when is surgery necessary? As far as I am concerned, as long as the central cornea is clear, contact lenses should be used, not surgery. This is even if the keratoconus is severe, with extreme thinning and bulging of the cornea. Some people experience scaring of the central cornea. If the scaring is dense and centrally located, contacts cannot improve the vision because the central cornea is no longer transparent. This is the only time that surgery should, be considered. It is a treatment of last resort.

Over the years we have noticed that people with keratoconus often make and confirm an appointment for an initial evaluation and then don’t show up. That’s curious. The people that could benefit most are least likely to show up. I have to wonder why. I think that the idea of having an eye exam is just too scary – they are afraid to hear the bad news. When you think about it, it’s hard to blame them. Every day they are reminded of their eye problem by their poor vision, and glasses don’t help. Many can’t even hold a job, and those that work, have to struggle through the day.

If this sounds like you, I just want to say – don’t be a chicken. Chances are I’ll be able to restore your good vision with contact lenses. It might take some time initially but, once fitted your keratoconus is just a minor inconvenience. I have succeeded with many patients who were told they can’t be fitted. We have so many choices of different lenses and techniques that I have almost never had to refer a patient for surgery. So take a deep breath, make your contact lens evaluation appointment, and show up. Get ready to hear the good news!

The front surface of the eye – the clear and transparent cornea – is supposed to be perfectly round, like a ping pong ball. Sometimes it is bent, like an egg or football shape. This results in an image which is blurred or distorted, and is called astigmatism. Astigmatism causes blurriness at all times and at all distances. If there is a lot of astigmatism, and if it is present from an early age, the visual system cannot develop in a normal way and AMBLYOPIA (lazy eye) results. Therefore, it is important to have your child’s eyes examined for the first time before the age of 3 years. This is one of the few times that glasses must be worn by a young child in order for his or her eyes to develop normally.

When the shape of the eye is very much distorted resulting in high astigmatism the use of CONTACT LENSES becomes somewhat more complicated. Rigid lenses (Rigid Gas Permeable) can cover the “bent” surface with a spherical one, essentially eliminating the astigmatism. Hybrid lenses like the “SYNERGEYES” lens or the “DUETTE” lens can accomplish the same thing with better comfort: this is because a hybrid lens has a rigid central area and a soft skirt. A third option for correcting high astigmatism is custom designed soft contact lenses.

Many people with high astigmatism are told that they can’t wear contact lenses. In our experience, this is almost never the case. We succeed in fitting even the most difficult cases. SO EVEN IF YOU HAVE HIGH ASTIGMATISM AND WERE TOLD YOU CAN’T WEAR CONTACTS, GIVE US A CALL – WE CAN ALMOST CERTAINLY HELP.